Faheem Heba Ahmed, Abdulmeged Nannes Adel, Hussein Hany Aly, Elmoursi Ahmed Abdelaziz, Elnaggar Heba T-Allah Mohammed Yousry, Ghait Ramy Samir
Internal Medicine and Hepatology, Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Egypt Liver J. 2022;12(1):27. doi: 10.1186/s43066-022-00188-x. Epub 2022 Apr 8.
Portal hypertension (PH) is a common consequence in hepatitis C virus cirrhotic patients. With interferon alpha-based therapy, SVR was linked to improved PH and fibrosis regression. SVR to oral antiviral regimens is linked to reduced portal pressure in patients with clinically significant portal hypertension (CSPH) at baseline. However, CSPH continues in most of the patients. This study aims to assess the reversibility and/or improvement of PH in Egyptian patients with HCV-related cirrhosis and CSPH after achieving SVR with DAAs. The second aim is to evaluate performance of the noninvasive markers of fibrosis in prediction of the presence and/or reversibility of the CSPH in correlation to radiological and endoscopic parameters.
We evaluated noninvasive parameters, radiological and endoscopic signs of PH at baseline, and/or SVR 24 and SVR 48 post-DAA therapy in 40 patients with cirrhosis and CSPH (group A) and another 40 patients with cirrhosis only (group B).
In group A, the spleen diameter decreased from baseline (15.74 ± 1.53 cm), and SVR 24 (15.48 ± 1.51), to SVR 48 (15.35 ± 1.49 cm). No ascites detected at SVR 48 in 62.5%. Portal vein diameter and portal vein blood velocity reduced to 13.53 ± 1.07 mm and 14.14 ± 2.2 cm/s at SVR 48, with reversibility of hepatic vein waveform towards the triphasic pattern. Medium to large esophageal varices regressed from 52.5% to 2.5%, and up to 70% of patients showed no EVs at SVR 48. In group A, 24 patients showed complete reversibility of CSPH, and 16 patients showed improvement of CSPH. Child-Pugh score, FIB-4 index, King's score, and Lok index revealed higher significance for detection of the presence of PH. Child-Pugh score, PC/SD ratio, and Lok index revealed higher significance for detection of reversibility of PH.
We concluded that CSPH improved after SVR with DAAs and completely regressed in some patients. Upon predicting the presence of PH, Child-Pugh score, FIB-4 index, King's score, and Lok index were the most significant noninvasive scores. While for predicting the reversibility of PH, Child-Pugh score, PC/SD ratio, and Lok index were the most significant scores.
门静脉高压（PH）是丙型肝炎病毒肝硬化患者的常见后果。基于α干扰素的治疗中，持续病毒学应答（SVR）与PH改善及纤维化消退相关。口服抗病毒方案的SVR与基线时具有临床显著门静脉高压（CSPH）患者的门静脉压力降低相关。然而，大多数患者的CSPH仍持续存在。本研究旨在评估在使用直接抗病毒药物（DAA）实现SVR后，埃及HCV相关肝硬化和CSPH患者中PH的可逆性和/或改善情况。第二个目的是评估纤维化的非侵入性标志物在预测CSPH的存在和/或可逆性方面与放射学和内镜参数的相关性表现。
我们评估了40例肝硬化和CSPH患者（A组）以及另外40例仅肝硬化患者（B组）在基线时、DAA治疗后SVR 24和SVR 48时的非侵入性参数、PH的放射学和内镜征象。
在A组中，脾脏直径从基线时的（15.74±1.53 cm）、SVR 24时的（15.48±1.51）降至SVR 48时的（15.35±1.49 cm）。62.5%的患者在SVR 48时未检测到腹水。门静脉直径和门静脉血流速度在SVR 48时降至13.53±1.07 mm和14.14±2.2 cm/s，肝静脉波形向三相模式可逆。中至大的食管静脉曲张从52.5%消退至2.5%，高达70%的患者在SVR 48时无食管静脉曲张。在A组中，24例患者的CSPH完全可逆，16例患者的CSPH有所改善。Child-Pugh评分、FIB-4指数、King评分和Lok指数在检测PH的存在方面显示出更高的显著性。Child-Pugh评分、PC/SD比值和Lok指数在检测PH的可逆性方面显示出更高的显著性。
我们得出结论，使用DAA实现SVR后CSPH有所改善，部分患者完全消退。在预测PH的存在时，Child-Pugh评分、FIB-4指数、King评分和Lok指数是最显著的非侵入性评分。而在预测PH的可逆性时，Child-Pugh评分、PC/SD比值和Lok指数是最显著的评分。
